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1. BY:
Tezeta Fekadu (B pharm), 2016
PSYCHIATRIC DISORDERS
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2.  Introduction
 Sleep Disorder
 Anxiety Disorder
 Schizophrenia
Outline
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3. Psychiatry: a medical speciality concerned with the
study, diagnosis, treatment and prevention of mental
disorders.
The word Psychiatry is derived from two Greek words:
‘psyche’ for soul or mind and ‘iatros’ for healer.
Mind: It is the functional capacity of brain (brain is an
anatomical structure.) e.g., intelligence, memory.
Personality: the characteristic way in which a person
thinks, feels and behaves.
Introduction
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4. Psychiatric assessment requires empathy and good
listening skills because it is based primarily upon
subjective interpretation and not objective tests.
A pt’s history is the single most important tool in
establishing a diagnosis.
Developing good rapport with pts is key to effective
interviewing and thorough data gathering.
Both the content (what the pt says and does not say) and
the manner in which it is expressed (body language,
topic shifting) are important.
Evaluation of Psychiatric Illness
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5. The Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
is the most widely accepted and most important
diagnostic reference used in the care of the mentally
ill.
It provides a common language for practitioners to
describe and diagnose psychiatric disorders.
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6. Should be conducted in a quiet, non stimulating and comfortable
area where the pt and the interviewer feel at ease.
Generally, open-ended questions come first, followed by questions
focused on more specific or personal data.
allow the pt to provide descriptions and other information in his
or her own words.
minimizes the risk of "leading" the pt.
The interviewer must be nonjudgmental about the information
offered by the pt to develop trust and rapport and to ensure
completeness and accuracy of the information.
Accurate record of the content of the examination
The Clinical Interview
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7. A. Identifying information:
 Age, sex, marital status, race, referral source.
B. Chief complaint(CC):
reason for consultation; the reason is usually a direct quote
from the pt.
C. History of present illness (HPI)
Current symptoms: date of onset, duration and course of
symptoms
 Previous psychiatric symptoms and treatment
Recent psychosocial stressors: stressful life events that may
have contributed to the pt‘s current presentation
Reason the pt is presenting now
Historical evidence in this section should be relevant to the
current presentation
Psychiatric History
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8. D. Past psychiatric history
Previous and current psychiatric diagnoses.
History of psychiatric treatment.
History of psychotropic medication use.
History of suicide attempts and potential lethality.
E. Past medical history (PMH)
Current and/or previous medical problems.
F. Family history (FH):
relatives with history of psychiatric disorders, suicide or
suicide attempts, alcohol or substance abuse.
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9. G. Social history
Source of income
Level of education, relationship history(including marriages,
number of children); individuals that currently live with pt
Support network
Current alcohol or illicit drug usage
Occupational history
H. Developmental history:
family structure during childhood, relationships with parental
figures and siblings, peer relationships, school performance.
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10. Medications for both psychiatric and medical conditions.
how each drug was tolerated and the nature of the response to
that drug(s).
All allergies must be noted.
Because most psychiatric medications have a delay in the
onset of effect, it is important to determine whether an
adequate trial (dose and duration) was provided before
the pt was deemed "nonresponsive" to that drug.
 If a pt has a history of non adherence, specific causes
(cost, complicated dosing schedules, lack of insight, &
ADR) should be investigated.
Medication History
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11. The mental status examination includes impressions of
the pt’s general appearance, mood, speech, actions, and
thoughts.
An assessment of the pt at the present time. Historical
information should not be included in this section
Provides an objective evaluation used in diagnosis,
assessment of the course of the illness, and response to
treatment.
The MSE has several components.
Mental Status Examination
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12. A. General appearance and behavior
 Grooming, level of hygiene, characteristics of clothing
 Unusual physical characteristics or movements
 Attitude: Ability to interact with the interviewer
 Psychomotor activity: Agitation or retardation
 Degree of eye contact
The interviewer should note whether the pt is
cooperative, mute, hostile, paranoid, guarded, or
withdrawn.
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13. B. Affect
Describes the pt's current emotional tone (facial expression, body
posture, and tone of voice) can be objectively observed by the
clinician.
Types of affect
Flat: absence of all or most affect
Blunted or restricted: moderately reduced range of affect
Labile: multiple abrupt changes in affect. A rapidly shifting
affect from one extreme to the other.
Inappropriate affect: e.g. when a pt laughs in a situation that
would be expected to produce sadness.
C. Mood: Describes feelings, which are subjectively reported by
the pt. Internal emotional tone of the pt (i.e. , dysphoric,
euphoric, angry, euthymic, anxious).
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14. D. Activity: motor activity may be excessive or
diminished.
Overactivity can include pacing; hand wringing; picking
at clothing, skin, or hair; inability to sit still during the
interview; and excessive hand gestures.
Underactive pts move less than expected.
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15. E. Speech and Language
Speech should be assessed as to whether it proceeds
logically in a goal-directed manner or whether the
content is vague and poorly organized.
Pressured speech: rapid speech, which is typical of
pts with manic disorder.
Poverty of speech: minimal responses, such as
answering just “ yes or no ”.
Thought blocking: sudden cessation of speech, often
in the middle of a statement without any obvious
reason.
Loosening of associations: illogical shifting b/n
unrelated topics 15

16. Circumstantial speech: lacks a clear direction because
of excess unnecessary information. Unnecessary
digression, which eventually reaches the point.
Tangential speech: thought that wanders from the
original point (ultimate point is never made).
Ideas of reference: interpreting unrelated events as
having direct reference to the pt, such as believing that
the TV is talking specifically to them
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17. Perseveration: is repetition of an original answer to
subsequent questions.
 Flight of ideas: is over productive, rapid speech during
which the pt jumps rapidly from one idea to the next.
Echolalia: echoing of words and phrases.
Mutism: the pt does not respond even though he or she
is aware of the discussion.
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18. F. Thought and Perceptual Disturbances
A variety of thought disturbances can occur in mental illness.
Delusions: are fixed, false beliefs that are not based in
reality or consistent with the pt's religion or culture.
Persecutory delusions: false belief that others are trying
to cause harm, or are spying with intent to cause harm.
Erotomanic delusions: false belief that a person, usually
of higher status, is in love with the pt.
Grandiose delusions: false belief of an inflated sense of
self-worth, power, knowledge, or wealth.
Somatic delusions: false belief that the pt has a physical
disorder or defect.
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19. Thought broadcasting: is the belief that one's
thoughts are audible to others.
Hallucinations: are false sensory impressions or
perceptions that occur in the absence of an external
stimulus.
Hallucinations can be auditory, visual, olfactory,
tactile, or gustatory and can be continuous or
intermittent.
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20. Illusions are visual misperceptions involving a
misinterpretation of a real sensory stimulus.
This phenomenon does not always indicate a psychiatric
illness and can be seen in persons without mental illness.
Obsessions are unwanted thoughts or ideas that intrude
into a person's thinking.
Compulsions are actions performed in response to the
obsessions or to control anxiety associated with the
obsession.
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21. G. Evaluation of Cognition
Check whether the pt has received medications with
sedative properties, because the outcome of the
examination can be altered if CNS depressants were
recently taken.
Sensorium, or level of consciousness, refers to the alertness
of the pt.
Attention and concentration can be assessed using serial
subtraction by 7s ("serial 7s") or 3s, or by having a pt spell
a five-letter word backward.
General intelligence can be assessed by asking factual
information about current news items, recent presidents, or
popular TV shows.
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22. Memory is the ability to recall past experiences and is classified
as sensory stores (which lasts seconds), short-term memory (the
ability to recall newly acquired information after several minutes),
working memory (i.e. immediate application of visual or auditory
instructions), and long-term or remote memory (historical facts).
Orientation to time, place, person, and situation assesses sensory
stores and short-term memory.
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23. Abstraction is the ability to interpret information such as a
proverb or identify similarities or differences b/n words (e.g.,
apple and orange).
Abstraction is influenced by education, cultures and
linguistic fluency; thus inability to abstract is not always a
sign of a psychiatric disorder.
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24. H. Insight and Judgment
Insight refers to pt awareness that he or she has a
mental illness and the impact of that illness on his or
her life.
pts typically demonstrate a lack of insight when they are
psychotic.
pts with poor insight are often non adherent with medications.
Judgment is the ability to make decisions appropriate
to the situation and can be impaired in a variety of
mental illnesses.
can be assessed by asking pts how they would handle either
their current or a hypothetical situation.
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25. Mini-Mental Status Examination (MMSE)
A structured interview that assesses many cognitive domains
(orientation, visuospatial organization, memory & reasoning)
to determine an overall score of cognitive function.
The maximum score is 30 & a score of 23 or less is indicative
of significant cognitive impairment.
The MMSE takes 5 to 10 minutes to administer and is used
routinely in the clinical setting.
Noise and distraction can affect the pt's performance ability;
therefore, the interview should be conducted in a quiet area
with adequate lighting.
The interviewer should speak slowly and clearly to the pt
when providing instructions or asking questions.
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26. A. Orientation (10 points)
 Year, season, date, day of wk, month
 State, county, town or city
 Hospital or clinic, floor
B. Registration (3 points)
 Name three objects: apple, table, pen
 Each must be spoken distinctly and with a
brief pause
 Pt repeats all three (1 point for each)
 Repeat process until all three objects have
been learned
 Record the number of trials needed to learn
all three objects
C. Attention and calculation (5
pts)
 Spell WORLD backward: DLROW.
 Points are given up to the first misplaced
letter. Example: DLORW scores as only 2
points.
D. Recall (3 points)
 Recite the three objects memorized in
B
E. Language (9 points)
 Pt names two objects when they
are displayed e.g. pencil & watch
(1 point each)
 Repeat a sentence:“No ifs, ands,
or buts.”
 Follow a three-stage command:
 Take a paper in your right hand.
 Fold it in half.
 Put it on the floor.
 Read and obey the following:
 Close your eyes
 Write a sentence
 Copy a design
MMSE
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